The cycle of acceptance: mental health professionals’ experience of workplace violence in a UK community mental health team
| Date | 20 June 2024 |
| Pages | 241-257 |
| DOI | https://doi.org/10.1108/MHRJ-04-2023-0020 |
| Published date | 20 June 2024 |
| Author | Helen Parr,Gaia Cetrano |
The cycle of acceptance: mental health
professionals’experience of workplace
violence in a UK community mental
health team
Helen Parr and Gaia Cetrano
Abstract
Purpose –Violence and aggressionagainst mental health professionals is a global concernwith well-
documentedconsequences. In the UK, mental healthcare is increasingly delivered in the community,yet
little research has explored practitioner experiences of workplace violence (WPV) outside of inpatient
settings. This study aimedto explore how mental health professionals in a UK community mental health
team (CMHT)perceive, experience and cope with WPV.
Design/methodology/approach –Face-to-face semi-structured interviews were conducted with ten
multidisciplinary professionals based in a CMHT in a UK city. Data was analysed using interpretative
phenomenologicalanalysis.
Findings –Three interconnected themes emerged. WPV was accepted as inevitable: partic ipants carried on
working despite its impact, and feeling unheard by management they gave up on change, perpetu ating the
perceived inevitability of WPV. Peer support and organisational resources like debriefing, counselling and
occupational health improved coping. Stigma and ideas of profession al responsibility were barriers to access.
Originality/value –To mitigate against the negative consequences of WPV, CMHTs could offer peer
support initiatives, improvecommunication and availability of organisational resources and involve staff
in post-incidentdecision-making. Recommendationsare made to shift the attitude of acceptance of WPV
and encouragehelp-seeking.
Keywords Workplace violence, Aggression, Community mentalhealth services, Peer support
Paper type Research paper
Introduction
Violence towards health-care staff is a globalissue (Al-Azzam et al.,2017;Yang et al.,2018;
Zelnick et al.,2013). Workplace violence (WPV) includes verbal abuse, sexual and racial
harassment, intimidation and physical assault (Mento et al.,2020;Guay et al.,2014). This
study uses the UK Department of Health’s (DoH) definition of WPV as “any incident in which
an employee is abused, threatened or assaulted in circumstances relating to their work”
(DoH, 1999).
While not all mental health service users are violent, and not all violence is enacted by
people with a mental health condition (Elbogen et al.,2016), WPV is more common in
mental health trusts than the NHS as a whole (Royal College of Nursing, 2018). In the NHS
Staff Survey 2017, over 80% of mental health nurses reported verbal abuse in the previous
12months, with 33% reporting physical violence (NHS, 2018). These figures do not
distinguish between inpatient and community, and though internationally WPV rates are
higher on wards (Renwick et al., 2016;Maguire and Ryan, 2007;McKinnon and Cross, 2008),
Helen Parr and Gaia
Cetrano are both based at
the Department of Social
Policy and Social Work,
University of York,
York, UK.
Received 21 April 2023
Revised 3 April 2024
Accepted 6 April 2024
Gaia Cetrano is also affiliated
with Middlesex University
London, Department of Mental
Health and Social Work,
London, UK.
The authors wish to thank all
those who supported and took
part in the study. The study was
unfunded.
DOI 10.1108/MHRJ-04-2023-0020 VOL. 29 NO. 32024, pp. 241-257, ©Emerald Publishing Limited, ISSN 1361-9322 jMENTAL HEALTH REVIEW JOURNAL jPAGE 241
this may be partly due to lower rates of reporting in the community (Fry et al., 2002;
Renwick et al., 2019). Research suggests the lifetime prevalence of WPV in mental health
care is approaching 100% (Bowers et al., 2011). This prevalence may exacerbate the
widespread conception in mental health care that experiencing violence is “part of the
job” (Anderson and West, 2011;van Leeuwen and Harte, 2011;Abderhalden et al., 2007;
Itzhaki et al., 2015).
WPV affects the individual, organisation and wider society (van Leeuwen and Harte, 2017;
Gates et al.,2011). Professionals experience serious health consequences (Hsieh et al.,
2018;Cavanaugh et al., 2014;Magnavita, 2014). Across cultures, settings and study
designs, emotional responses to WPV consistently include anger, fear, blame and shame
(Lanctot and Guay, 2014;Needham et al., 2005;Konttila et al.,2018). Burnout describes
emotional disengagement, depersonalisation and poor personal accomplishment (Maslach
and Jackson, 1981), and is commonly reportedfollowing WPV (Laschinger and Grau, 2012;
Paterson et al.,2008). WPV negatively impacts the overall quality of care (Atan et al.,2013;
Stadnyk, 2012), even creating conditions that perpetuate further violence(Camerino et al.,
2008;Itzhaki et al., 2018) and, in inpatient settings, leading to potentially harmful restrictive
interventions (Cusacket al.,2018;Scholes et al., 2022).
Following an incident, supporting staff at a personal, team and organisational level is crucial
to mitigate the impact of WPV (Stevenson et al.,2015). Peer support and proactive support
from management are commonly found to promote coping (Jussab and Murphy, 2015;
Baby et al.,2014). Organisational interventions such as debriefing, skills training and
resilience building meetings (Jacobowitz, 2013) and formalised peer support initiatives are
gaining evidence (Bakes-Denman et al.,2021). However, stigma, poor provision of
resources and organisational attitudes to WPV may present barriers to accessing support
(Rodrigues et al.,2021;Dean et al., 2021;Bakes-Denmanet al., 2021).
Therefore, understanding how professionals conceptualise and cope with WPV is
imperative to improving support and reducing negative outcomes (Rodrigues et al.,2021).
However, studies into mental health professionals’ experiences to date usually focus
exclusively on inpatient staff or do not differentiate between ward and community
participants (Campbell, 2017). Theories of adaptation have been proposed for American
psychiatric inpatient nurses, who reframe and reflect following WPV (Dean et al.,2021), and
Australian nurses across hospital departments, who cope by finding meaning, mastery and
self-enhancement (wearing WPV as a “badge of honour”; Chapman et al., 2010, p. 192). In
contrast, according to Rodrigues et al. (2021), Canadian inpatient mental health
practitioners seek validation after WPV, reporting professional culture and expectations of
resilience affecting their experience of WPV. Inpatient and community staff in New Zealand
experienced WPV as a violation (Baby et al., 2014), and the authors describe a cycle of
resulting personal and professional changes precipitating poorer care outcomes. Jussab
and Murphy (2015) interpretive phenomenological analysis of inpatient and community
psychologists’ accounts of WPV in the UK identified moment-to-moment experiences of
fear, self-doubt and vulnerabilityfollowing WPV.
The experience of WPV is subjective (van Leeuwen and Harte, 2011) and likely to differ
between different working environmentsand professional roles (Havaei et al.,2019;Cheung
et al., 2017). Differences in staff and inpatients’ perspectives on the causes of violencehave
been attributed to ward culture and interactional dynamics (Fletcher et al., 2021), and
professionals’ experienceof WPV is likely to differ between hospital and community settings
(NCCMH, 2015;Maguire and Ryan, 2007;Baby et al.,2014). The only entirely community-
based study we found surveyed psychiatric visiting nurses who experiencedWPV in Japan,
83% of whom reported residual psychological distress (Fujimoto et al.,2017). To the best of
our knowledge, there are no published qualitative studies elucidating community mental
health professionals’ experiencesof WPV.
PAGE 242 jMENTAL HEALTH REVIEW JOURNAL jVOL. 29 NO. 32024
Get this document and AI-powered insights with a free trial of vLex and Vincent AI
Get Started for FreeStart Your 3-day Free Trial of vLex and Vincent AI, Your Precision-Engineered Legal Assistant
-
Access comprehensive legal content with no limitations across vLex's unparalleled global legal database
-
Build stronger arguments with verified citations and CERT citator that tracks case history and precedential strength
-
Transform your legal research from hours to minutes with Vincent AI's intelligent search and analysis capabilities
-
Elevate your practice by focusing your expertise where it matters most while Vincent handles the heavy lifting
Start Your 3-day Free Trial of vLex and Vincent AI, Your Precision-Engineered Legal Assistant
-
Access comprehensive legal content with no limitations across vLex's unparalleled global legal database
-
Build stronger arguments with verified citations and CERT citator that tracks case history and precedential strength
-
Transform your legal research from hours to minutes with Vincent AI's intelligent search and analysis capabilities
-
Elevate your practice by focusing your expertise where it matters most while Vincent handles the heavy lifting
Start Your 3-day Free Trial of vLex and Vincent AI, Your Precision-Engineered Legal Assistant
-
Access comprehensive legal content with no limitations across vLex's unparalleled global legal database
-
Build stronger arguments with verified citations and CERT citator that tracks case history and precedential strength
-
Transform your legal research from hours to minutes with Vincent AI's intelligent search and analysis capabilities
-
Elevate your practice by focusing your expertise where it matters most while Vincent handles the heavy lifting
Start Your 3-day Free Trial of vLex and Vincent AI, Your Precision-Engineered Legal Assistant
-
Access comprehensive legal content with no limitations across vLex's unparalleled global legal database
-
Build stronger arguments with verified citations and CERT citator that tracks case history and precedential strength
-
Transform your legal research from hours to minutes with Vincent AI's intelligent search and analysis capabilities
-
Elevate your practice by focusing your expertise where it matters most while Vincent handles the heavy lifting
Start Your 3-day Free Trial of vLex and Vincent AI, Your Precision-Engineered Legal Assistant
-
Access comprehensive legal content with no limitations across vLex's unparalleled global legal database
-
Build stronger arguments with verified citations and CERT citator that tracks case history and precedential strength
-
Transform your legal research from hours to minutes with Vincent AI's intelligent search and analysis capabilities
-
Elevate your practice by focusing your expertise where it matters most while Vincent handles the heavy lifting